Transplant Ureter Stricture: Acucise Endoureterotomy and Balloon Dilation are Effective

Bhayani, Sam B.; Landman, Jaime; Slotoroff, Craig; Figenshau, R. Sherburne

doi:10.1089/089277903321196733

Cited by 39 publications

(22 citation statements)

References 18 publications

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“…Bhayani et al reported outcomes in 8 patients with ureteral strictures, with 4 undergoing Acucise endoureterotomy and the other 4 balloon dilation. 1 Success rates were 67% and 75% with mean follow-up of 20 months and 23.7 months for Acucise and balloon dilation. A separate study by Fontaine et al evaluated 17 patients with leaks and 44 with obstruction who were treated with percutaneous ureteral therapy; patients underwent percutaneous nephrostomy followed by antegrade placement of nephroureteral stent.…”

Section: Discussionmentioning

confidence: 91%

“…The most common postoperative complication is ureteral stricture at the ureterovesical anastomosis, with reported incidence rates up to 10%. 1-9 Strictures often lead to hydronephrosis and risk permanent damage to the renal allograft. Other postoperative urologic complications include ureteral leaks that commonly occur at the surgical anastomosis or less often the renal collecting system, with incidence rates up to 5.4%.…”

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confidence: 99%

“…11 Open-surgery techniques have been used for the correction of postoperative urological complications; however, these procedures have been associated with higher morbidity, delayed convalescence, and may be technically challenging. 1,7 …”

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confidence: 99%

“…1,7,14–18 Though there is a demonstrated success in treatment of ureteral strictures and leaks with percutaneous ureteral interventions, literature remains sparse regarding long-term transplant outcomes. In this single-center retrospective study, we examine long-term graft and patient survival outcomes in transplant recipients with previous percutaneous management of ureteral complications.…”

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confidence: 99%

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Outcomes of Kidney Transplant Recipients With Percutaneous Ureteral Interventions: A Single-Center Study

Srinivasan

Stoffel

James

et al. 2017

Transplantation Direct

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BackgroundLong-term outcomes of kidney transplantation recipients with percutaneous ureteral management of transplant ureteral complications are not well characterized.MethodsElectronic records of 1753 recipients of kidney-alone transplant between January 2000 and December 2008 were reviewed. One hundred thirty-one patients were identified to have undergone percutaneous ureteral management, with placement of percutaneous nephrostomy tube or additional intervention (nephroureteral stenting and/or balloon dilation). Indications for intervention included transplant ureteral stricture or ureteral leak. Kaplan-Meier survival curves and multivariable regression modeling were performed to determine survival outcomes.ResultsKaplan- Meier graft survival (P = 0.04) was lower in patients with percutaneous ureteral intervention for transplant ureteral complication. Graft survival at 1, 5, and 10 years was 94.3% 78.3%, and 59.1% for no intervention and 97.2%, 72.1%, and 36.2% for intervention cohort. Patient survival (P = 0.69) was similar between cohorts. Multivariate analysis demonstrated no association with graft failure (hazard ratio, 1.21; 95% confidence interval, 0.67-2.19; P = 0.53) or patient death (hazard ratio, 0.56; 95% confidence interval, 0.22-1.41; P = 0.22) in intervention group. The major cause of graft failure was infection for percutaneous ureteral intervention group (20.4%) and chronic rejection for those without intervention (17.3%).ConclusionsKidney transplant recipients with percutaneous ureteral interventions for ureteral complications do not have a significant difference in graft and patient survival outcomes. Therefore, aggressive nonoperative management can be confidently pursued in the appropriate clinical setting.

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Section: Discussionmentioning

confidence: 91%

mentioning

confidence: 99%

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confidence: 99%

mentioning

confidence: 99%

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Outcomes of Kidney Transplant Recipients With Percutaneous Ureteral Interventions: A Single-Center Study

Srinivasan

Stoffel

James

et al. 2017

Transplantation Direct

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“…An antegrade approach was used in 2 patients because of proximal ureteral strictures and coexisting kidney stones which were managed in the same session. In 3 patients who had complete ureteral occlusion, combined antegrade and retrograde approaches for utilizing the 'cut-to-the-light' technique were performed as described by Lopatkin et al [5] and Bhayati et al [6].…”

Section: Antegrade or Retrograde Endoureterotomymentioning

confidence: 99%

Endoscopic Treatment of Ureteric Strictures: Acucise, Cold-Knife Endoureterotomy and Wall Stents as a Salvage Approach

et al. 2005

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Objective: To evaluate the factors influencing the results of endoureterotomy using cold-knife and cutting balloon dilatation, and permanent ureteral wall stents in patients with benign ureteral strictures after different operations affecting the ureter. Materials and Methods: Over a 4-year period, in 18 patients, endoscopic cold-knife and Acucise endoureterotomies were performed in 13 and 7 renal units, respectively. Eight Memoterm permanent ureteral wall stents were inserted into 7 patients when endoureterotomy failed. Successful outcome was defined by the absence of re-stricture assessed both clinically and radiologically. Results: The strictures were secondary to ureterolithotomy in 6, ureteroscopy in 3, gynecological procedures in 4, abdominal surgeries in 2, transplantation in 2 and continent urinary diversion in 1. The right and left ureters were unilaterally affected in 5 and 11 patients, respectively (5 of them had a solitary kidney), while the remaining 2 patients had bilateral ureteral strictures. We achieved total ureteral patency of 3 (43%) and 7 (54%) renal units with Acucise and cold-knife incision, respectively. Obstructive uropathy was resolved in 6 renal units (75%) of 8 using ureteral wall stents. Conclusion: Endoureterotomy with cold-knife or Acucise cutting balloon dilatation is effective in the treatment of iatrogenic ureteral strictures, but only in a selected group. Based on our results, the favorable prognostic criteria for endoureterotomy are the length (≤1.5 cm), the nonischemic nature of the stricture and adequate renal function. As a salvage approach, permanent self-expanding ureteral wall stents with a 75% success rate may provide a satisfactory outcome for decompression of an obstructed system.

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Distal Ureteral Strictures

Herati

Atalla²

2012

Smith's Textbook of Endourology

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Transplant Ureter Stricture: Acucise Endoureterotomy and Balloon Dilation are Effective

Abstract: As our results are comparable to those of other published series, endourologic management of transplant ureteral stenosis is a reasonable strategy.

Cited by 39 publications

References 18 publications

Outcomes of Kidney Transplant Recipients With Percutaneous Ureteral Interventions: A Single-Center Study

Outcomes of Kidney Transplant Recipients With Percutaneous Ureteral Interventions: A Single-Center Study

Endoscopic Treatment of Ureteric Strictures: Acucise, Cold-Knife Endoureterotomy and Wall Stents as a Salvage Approach

Distal Ureteral Strictures

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